Infliximab therapy rescues cyclophosphamide failure in severe central nervous system sarcoidosis

Central nervous system involvement is a severe manifestation of sarcoidosis that often requires aggressive immunosuppressive therapy. The most efficacious approach for refractory disease is unknown. We reviewed the cases of four subjects who demonstrated active progression of neurosarcoidosis while under treatment with cyclophosphamide, and who were subsequently treated with infliximab. All four subjects demonstrated rapid and substantial reversal of their clinical course. Radiologic findings were concordant with the clinical responses. There were no notable toxicities. Treatment with infliximab may be more effective than cyclophosphamide for refractory central nervous system sarcoidosis. A larger, prospective study is warranted.